前列腺增生患者应用非那雄胺治疗前后前列腺移行带体积变化的临床意义

Clinical significance of transitional zone volume in benign prostatic hyperplasia patients before and after finasteride treatment

目的分析长期服用非那雄胺治疗良性前列腺(BPH)患者的下尿路症状(LUTS)疗效与超声测得的前列腺移行带参数的相关性。方法本研究共纳入77例患者,服用非那雄胺前后随访至少1年。所有患者均进行了经直肠超声前列腺检测,测得的前列腺形态参数包括前列腺体积(PV)、移行带体积(TZV)和移行带指数(TZI),并且记录了患者的国际前列腺症状评分(IPSS),进一步分析IPSS与前列腺超声形态参数之间的关系。结果长时间服用非那雄胺可以显著性减少PV[(-2.56±20.14)%,P=0.0261]、TZV[(-8.24±27.04)%,P=0.0006]和TZI[(-5.54±21.41)%,P=0.0014],并且可以显著改善LUTS(IPSS下降2.40±3.80,P<0.0001)。并且通过Pearson相关性分析显示:ΔTZV与ΔIPSS存在显著相关性(Pearson r=0.7430,r 2=0.5521,P<0.0001),受试者工作特性曲线下面积(AUC)为0.960,临界值为-1.10 mL(P<0.001)。结论长期服用非那雄安可以降低PV、TZV和TZI,减轻患者的LUTS,并且TZV减低明显的患者可以显著性改善IPSS;ΔTZV可以作为评估和管理BPH/LUTS的有效指标,特别是对于长期服用非那雄胺的前列腺增生患者。

Objective To analyze the effects of long-term finasteride treatment on prostatic morphology and lower urinary tract symptoms(LUTS)in benign prostatic hyperplasia(BPH)patients,and the correlation between LUTS severity and prostatic morphological parameters.Methods A total of 77 LUTS/BPH patients who had a baseline transrectal ultrasound(TRUS)prior to finasteride initiation and subsequent TRUS follow-up were selected.Prostatic anatomical factors were analyzed,including prostate volume(PV),transitional zone volume(TZV)and transitional zone index(TZI)before and after more than 1 year finasteride treatment,as well as the correlation with international prostate syndrome score(IPSS).Results Long-term finasteride treatment significantly reduced PV[(-2.56±20.14)%,P=0.0261]、TZV[(-8.24±27.04)%,P=0.0006]and TZI[(-5.54±21.41)%,P=0.0014],and ameliorated LUTS(IPSS reduced by 2.40±3.80,P<0.0001).Pearson correlation analysis showed a significant correlation betweenΔTZV andΔIPSS(Pearson r=0.7430,r 2=0.5521,P<0.0001).The area under the receiver operating characteristic(ROC)curve(AUC)was 0.960,and cut-off value was-1.10 mL(P<0.001).Conclusion Long-term finasteride treatment can significantly reduce PV,TZV and TZI,and improve LUTS in BPH patients.The reduction of TZV by finasteride treatment indicates an obvious improvement of IPSS.ΔTZV shows a very meaningful prediction value of IPSS variation and is considered as a potential candidate for evaluating and managing LUTS/BPH patients,especially in those taking long-term finasteride.